title: Foot orthoses and physiotherapy in the treatment of patellofemoral pain syndrome: randomised clinical trial.
abstract: OBJECTIVE
  To compare the clinical efficacy of foot orthoses in the management of patellofemoral pain syndrome with flat inserts or physiotherapy, and to investigate the effectiveness of foot orthoses plus physiotherapy.
  
  
  METHODS
  Prospective, single blind, randomised clinical trial.
  
  
  METHODS
  Single centre trial within a community setting in Brisbane, Australia.
  
  
  METHODS
  179 participants (100 women) aged 18 to 40 years, with a clinical diagnosis of patellofemoral pain syndrome of greater than six weeks' duration, who had no previous treatment with foot orthoses or physiotherapy in the preceding 12 months.
  
  
  METHODS
  Six weeks of physiotherapist intervention with off the shelf foot orthoses, flat inserts, multimodal physiotherapy (patellofemoral joint mobilisation, patellar taping, quadriceps muscle retraining, and education), or foot orthoses plus physiotherapy.
  
  
  METHODS
  Global improvement, severity of usual and worst pain over the preceding week, anterior knee pain scale, and functional index questionnaire measured at 6, 12, and 52 weeks.
  
  
  RESULTS
  Foot orthoses produced improvement beyond that of flat inserts in the short term, notably at six weeks (relative risk reduction 0.66, 99% confidence interval 0.05 to 1.17; NNT 4 (99% confidence interval 2 to 51). No significant differences were found between foot orthoses and physiotherapy, or between physiotherapy and physiotherapy plus orthoses. All groups showed clinically meaningful improvements in primary outcomes over 52 weeks.
  
  
  CONCLUSIONS
  While foot orthoses are superior to flat inserts according to participants' overall perception, they are similar to physiotherapy and do not improve outcomes when added to physiotherapy in the short term management of patellofemoral pain. Given the long term improvement observed in all treatment groups, general practitioners may seek to hasten recovery by prescribing prefabricated orthoses.
  
  
  BACKGROUND
  Australian Clinical Trials Registry ACTRN012605000463673 and ClinicalTrials.gov NCT00118521.
authors.affiliation: School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia 4072.
authors.forename: Natalie
authors.initials: N
authors.lastname: Collins
authors.forename: Kay
authors.initials: K
authors.lastname: Crossley
authors.forename: Elaine
authors.initials: E
authors.lastname: Beller
authors.forename: Ross
authors.initials: R
authors.lastname: Darnell
authors.forename: Thomas
authors.initials: T
authors.lastname: McPoil
authors.forename: Bill
authors.initials: B
authors.lastname: Vicenzino
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D009989:Orthotic Devices; D046788:Patellofemoral Pain Syndrome / Q000534:rehabilitation*; D026741:Physical Therapy Modalities; D011446:Prospective Studies; D016037:Single-Blind Method; D016896:Treatment Outcome